Recommendations for participation in contact sports in certain cervical spine conditions, part A

Condition	Contraindication to play
Condition	Absolute	Relative*	None*
Congenital anomalies
Odontoid agenesis, hypoplasia or os odontoidium	X
Type 1 Klippel-Feil^¶ mass fusion	X
Type 2 Klippel-Feil^Δ congenital one-level fusion			X
Atlanto-occipital fusion	X
Spina bifida occulta			X
Atlantoaxial conditions
Atlantoaxial instability	X
Atlantoaxial rotary fixation	X
Stenosis of the spinal canal
Spear tackler's spine	X
Developmental stenosis of the spinal canal (canal/vertebral body ratio <0.8)			X
Developmental stenosis of the spinal canal with:
Ligamentous instability	X
Cervical cord neurapraxia with signs or symptoms lasting more than 36 hours	X
Multiple episodes of cervical cord neurapraxia	X
Developmental stenosis of the spinal canal with:
Episode of cervical cord neurapraxia		X
Intervertebral disk disease		X
MRI evidence of cord compression		X
Burners
Recurrent acute and chronic burners		X
Resolved burner			X

* Provided individual is asymptomatic and neurologically normal and has full range of pain-free cervical motion.
¶ Type 1 Klippel-Feil anomaly: a mass fusion of the cervical and upper thoracic vertebrae.
Δ Type 2 Klippel-Feil anomaly: one- or two-level cervical fusion with full range of cervical motion, with no evidence of spinal instability or the presence of cervical disk disease or other degenerative changes.

Adapted from Torg, JS, Ramsey-Emrhein, JA. Cervical spine and brachial plexus injuries: Return-to-play recommendations. Phys Sportsmed 1997; 25.

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Recommendations for participation in contact sports in certain cervical spine conditions, part A